Strange bedfellows

Risk & Insurance, May, 2004 by Peter Rousmaniere

This may be a facet of our times, but in the workers' compensation field the mundane and the catastrophic sleep in the same bed. As a regulator turns a page in Harrisburg, Concentra receives a case referral in Charlotte and an underwriter in St. Louis makes an approval she'll soon rue. Yet as this modern age plows ahead, it casts terrible worker injury risks in its wake. Where are you in this picture? What motivates you about the future?

Let's recall how this field evolved before you joined. Work injury, like unemployment, was unknown as a social misfortune before the late 19th century. Frankensteins of early farm machinery ensnared our recent ancestors in new risks of injury and dealth. One of yours may even have suffered such an injury.

Then, in the late 19th century, a conservative regime in Germany created a modern workers' comp system. Franz Kafka's day job was at the government insurance company, recording in ink safety misdeeds of employers. Many of us are daughters and sons of Kafka, routinely at our desks but without the inkwell. Do you know how the office staffs of American workers' comp carriers influenced the architecture of buildings? You can still find headquarters fitted out with escalators. Workforces arrived and exited at regimented time slots more efficiently with escalators than elevators. Now computers and offshore workers at their terminals do the job.

How mundane, yet the workers' comp system has been an imperfect safety net against catastrophe. You just may find it hard to see this through the prism of your job. That is partly due to fragmentation of knowledge. Actuaries, loss prevention and medical managers may be working on the same corporate risk but never know it. The field has a walled in, sclerotic frame of mind. Among insurers in particular, hardly any senior executives come from covered industries even though the fundamental perils and cures in workers' comp usually start and end at the workplace. The combined research budget for the industry is a rounding error.

Few people enter our field with the zeal of missionaries. A quarter of active claims adjusters seem to have started out when a friend's father had an opening at Liberty Mutual in claims. America, on the other hand, implicitly expects much more. America expects us to be risk managers for the core value in our society: an individual's ability to work.

Without fanfare we turn repeatedly to face what I like to call black winds of injury and death. A black wind is a new peril of injury, which at its coming we barely understand and for which we have no solution. Carpal tunnel was a black wind, as was asbestos, as chronic pain is today. We all are risk managers today, knitting black winds into fair breezes.

Consider this new black wind coming up from the south. The hand that picks the produce you buy at the supermarket may well be that of a poorly educated, illegal immigrant with impaired or no worker safety protections. Consider another black wind. According to studies on the quality of medical care for serious workers' injuries, well over half of the medical decision-making was not only harmful but in violation of practice standards.

Edwin Land, the inventor of the instant camera, said that the perfect job is one dedicated to solving problems that appear unsolvable. Step back a bit. Is he describing your future?

PETER ROUSMANIERE writes monthly for Risk & Insurance. He can be reached at riskletters@trp.com